Ch 53 PrepU Assessment of Kidney & Urinary Fxn

The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 10:1 b) 8:1 c) 4:1 d) 6:1

A A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

The most frequent reason for admission to skilled care facilities includes which of the following? a) Stroke b) Urinary incontinence c) Congestive heart failure d) Myocardial infarction

B

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? a) Client reports increasing fatigue. b) Urine output is 100 ml/hr. c) Client rates pain at a 3 on a scale of 0 to 10. d) Client denies frequency and urgency.

A Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Kidney stones Chronic renal failure Fistula Neurogenic bladder

A A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.

When the bladder contains 400 to 500 mL of urine, this is referred to as functional capacity. anuria. renal clearance. specific gravity.

A. A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to drink liberal amounts of fluids. maintain bed rest for 2 hours. notify the health care team if bloody urine is noted. carefully handle urine because it is radioactive.

A. After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Inner layer of epithelium Detrusor muscle Submucosal layer of connective tissue Adventitia (connective tissue)

B. The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.

The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects?

BUN and serum creatinine the client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?

"I took my blood pressure medication with my morning coffee an hour ago." The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150 mL The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine.

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? a) "This medication will relieve your pain." b) "This medication will treat the blood in your urine." c) "This medication prevents infection in your urinary tract" d) "This medication prevents urinary incontinence."

A Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? Dullness Tympany Flatness Resonance

A. Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

A patient who complains of a dull, continuous pain in the suprapubic area that occurs with and at the end of voiding would most likely be diagnosed with which of the following? a) A kidney stone b) Interstitial cystitis c) Prostatic cancer d) Acute pyelonephritis

B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Proteinuria d) Chronic kidney disease

D A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

Which value does the nurse recognize as the best clinical measure of renal function? Volume of urine output Circulating ADH concentration Urine-specific gravity Creatinine clearance

D Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? Distract the patient's attention from the pain. Enable the patient to sit up and ambulate. Provide analgesics to the patient. Assess the patient's back and shoulder areas for signs of internal bleeding.

D. After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

Retention of which electrolyte is the most life-threatening effect of renal failure? Phosphorous Calcium Sodium Potassium

D. Retention of potassium is the most life-threatening effect of renal failure.

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.

Urine: RBC 20 BUN 28 mg/dL Hematuria (> 3RBCs) and an elevated BUN are both suggestive of a problem within the genitourinary tract. A serum creatinine of 0.8 mg/dL and a urine specific gravity of 1.020 are within normal limits. A rare white blood cell is not clinically significant.

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?

When the urine output is less than 30 mL/h Oliguria is defined as urine output <0.5 mL/kg/h

Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? Provide analgesics to the client. Distract the client's attention from the pain. Assess the patient's back and shoulder areas for signs of internal bleeding. Enable the client to sit up and ambulate.

C.

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? phenazopyridine hydrochloride Infection Metronidazole Phenytoin

A Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridium hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? Monitor the client for an allergy to iodine contrast material. Evaluate the client for periorbital edema. Assess the client's mental changes. Monitor the client for signs of electrolyte and water imbalance.

A. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.

Which is an effect of aging on upper and lower urinary tract function? More prone to develop hypernatremia Acid-base balance Increased blood flow to the kidneys Increased glomerular filtration rate

A. The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Vasopressin Cortisol Renin Albumin

C. Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).

The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client? "You will be sent home with a urinary catheter." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "Contact the primary provider if you experience fever, chills, or lower back pain." "You can stop taking the prescribed antibiotic."

C. The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur. The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Obstruction of the lower urinary tract Nephrotic syndrome Acute renal failure Infection

D. Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? chloride glucose potassium creatinine

B. Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client? Palpate pedal pulses. Monitor site condition. All options are correct. Monitor hypersensitivity response.

C. After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.

The term used to describe total urine output less than 0.5 mL/kg/hr is anuria. dysuria. nocturia. oliguria.

D. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

When describing the functions of the kidney to a client, which of the following would the nurse include? Control of water balance Regulation of white blood cell production Synthesis of vitamin K Secretion of enzymes

A. Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? a) Bladder ultrasonography b) Computed tomography with contrast c) Cystoscopy d) Radiography

B The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely. B. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. C. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. D. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.

D. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.

A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? "I don't like needles." "I take medication to help me sleep at night." "I have had a test similar to this one in the past." "I am allergic to shrimp."

D. The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Hematuria Anuria Dysuria Enuresis

D. The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.

The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Bleeding Dehydration Infection Allergic reaction

A. Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

A. Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? "I can resume my usual activities without restriction." "It is normal for my urine to be blood-tinged." "I should increase my fluid intake for the rest of the day." "If I have difficulty urinating, I should contact my physician."

A. A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? a) Pain after voiding b) Suprapubic pain c) Costovertebal angle tenderness d) Perineal pain

C Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Dehydration Infection Allergic reaction Bleeding

D. Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

When fluid intake is normal, the specific gravity of urine should be: 1.000 Less than 1.010 Greater than 1.025 1.010 to 1.025

D. Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? "I will feel a warm sensation as the dye is injected." "I will need to drink all of the dye as quickly as possible." "I should remove all jewelry before the test." "I should let the staff know if I feel claustrophobic."

A. A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) NSAIDs b) Strenuous exercise c) Prolonged standing d) Diabetes mellitus e) Fever

B, C, E Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? a) Excretory urogram b) Cystoscopy c) Intravenous pyelography d) Renal angiography

B. Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

The term used to describe painful or difficult urination is which of the following? a) Oliguria b) Anuria c) Nocturia d) Dysuria

D Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.

The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. Renal papilla Renal cortex Renal medulla Renal pelvis

B. The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 20% b) 40% c) 50% d) 30%

C Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? Uric acid level Blood urea nitrogen (BUN) Creatinine clearance level BUN to creatinine ratio

C. The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a) "You don't need to do any fasting before this noninvasive test." b) "You'll have a pressure dressing on your groin after the test." c) "A contrast medium will be used to help see the structures better." d) "An x-ray will be done to view your kidneys, ureters, and bladder."

A Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? Creatinine clearance level Serum potassium level Blood urea nitrogen level Uric acid level

A. Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Glomerulonephritis Decreased fluid intake Increased fluid intake Diabetes insipidus

B. When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 10 b) 30 c) 20 d) 40

C. Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 liters per day of filtrate.

The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? The specific gravity will be low The specific gravity will equal to one The specific gravity will be high. The specific gravity will be inversely proportional

C. The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.

The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur? Severe abdominal pain Diarrhea Nausea and emesis Blood-tinged urine

D. Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm Sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The client should not experience severe abdominal pain.

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? Pruritus Unusually smooth skin Hypoventilation Increased alertness

A. The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? Creatinine clearance GI absorption rate Liver function studies Therapeutic index

A. The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: microorganism transfer. incorrect urine output values. client discomfort. prostate irritation.

A. Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Increased serum creatinine Increased serum albumin Decreased potassium Decreased blood urea nitrogen (BUN)

A. In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: renal calculi. interstitial cystitis. an overdistended bladder. acute prostatitis.

A. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: 1 to 2 L/day 2.5 to 3 L/day 3.5 to 4 L/day 0.4 to 0.8 L/day

A. The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.

When fluid intake is normal, the specific gravity of urine should be which of the following? 1.010 to 1.025. >1.025. 1.000. <1.010.

A. Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine specific gravity >1.025 may indicate dehydration.

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? "Do you take multiple vitamin preparations?" "Have you had a recent urinary tract infection?" "Do you take phenytoin daily?" "Have you noticed any vaginal bleeding?"

A. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.

Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: Strain all urine for 48 hours. Encourage high fluid intake. Monitor for hematuria. Apply moist heat to the flank area.

B. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? 6 hours after the urine is discarded After discarding the 8:00 am specimen With the first specimen voided after 8:00 am At 8:00 am, with or without a specimen

B. A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? Around the umbilicus The costovertebral angle Above the symphysis pubis The upper abdominal quadrants on the left and right side

B. The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? Urinary incontinence Urinary urgency Urinary stasis Urinary frequency

B. The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

-Which of the following hormones is secreted by the juxtaglomerular apparatus? Calcitonin Antidiuretic hormone (ADH) Renin Aldosterone

C. Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? Urethra Bladder Ureters Pelvic floor muscles

C. The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

Which nursing assessment finding indicates the client has not met expected outcomes? a) The client consumes 75% of lunch following an intravenous pyelogram. b) The client has blood-tinged urine following brush biopsy. c) The client reports a pain rating of 3 two hours post-kidney biopsy. d) The client voids 75 cc four hours post cystoscopy.

D. Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.